Provider Demographics
NPI:1184974743
Name:CAROLINA WOMEN'S PHYSICAL THERAPY AND WELLNESS
Entity type:Organization
Organization Name:CAROLINA WOMEN'S PHYSICAL THERAPY AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMBERS-LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-386-8610
Mailing Address - Street 1:304 FAVERSHAM CRES
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7003
Mailing Address - Country:US
Mailing Address - Phone:803-386-8610
Mailing Address - Fax:
Practice Address - Street 1:4015 FOREST DR STE 101
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-4350
Practice Address - Country:US
Practice Address - Phone:803-386-8610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-11
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5018261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy